Ovulation Induction

• Clomiphene citrate (Clomid, Serophene) treatment. Clomiphene citrate (Clomid® Serophene&reg): A pill that causes ovulation (the release of eggs from the ovary) by inducing the production of follicle stimulating hormone. This is commonly used to treat women with Polycystic Ovarian Syndrome (PCOS) or unexplained infertility. Patients take one to three tablets by mouth daily for five days (usually cycle days 5 - 9). They are monitored with ovulation predictor kits, ultrasound and/or blood tests to check for ovulation. On the appropriate day, ovulation is triggered with an injection of human chorionic gonadotropin (hCG) followed by intercourse or intrauterine insemination (IUI, see below).
• Gonadotropin treatment. These are fertility injections containing follicle stimulating hormone (FSH, Gonal-F, Follistim, Bravelle) or a combination of FSH and luteinizing hormone (LH) (Repronex, Menopur). They are used for ovulation induction in patients that do not ovulte on their own. They are also used for superovulation (controlled ovarian hyperstimulation) where the ovaries are stimulated to produce more than one egg to increase the chance of conception. The injections are started on cycle day-3 and continue for approximately 10 days based on ovarian reserve. The cycle is monitored with serial blood tests and ultrasounds. On the appropriate day, ovulation is triggered with an injection of hCG followed by intercourse or IUI.

Management of polycystic ovarian disease (PCO). In obese patients with PCO, diet and exercise remain the mainstay of treatment. Metformin (Glucophage XR) is a pill prescribed to women with insulin resistance and/or PCO. This drug is often used in diabetes, and helps lower levels of insulin. It often helps restore normal menstrual cycles in women who do not normally ovulate. A thorough discussion on PCO is included here.